Although the Center for Medicare and Medicaid Services reimburses clinicians for advance-care planning when Medicare patients are seen for their yearly wellness visits, there is no real encouragement to patients themselves to put such plans in place. In fact, two thirds of American adults have no advance directives for their own health care should they be unable to make their wishes known. And that makes it tough to see that a patient's wishes are carried out — particularly since the patient's family may not even be aware of where that form is and what it calls for.
Lawmakers and health care groups are pushing to remedy that, according to a report in Modern Healthcare. Senators Bill Cassidy, R-LA, John Barrasso, R-WY and Michael Bennet, D-CO are hoping to get the CMS to become actively involved in making sure that advance directives are in place. To that end, they recently reintroduced the Medicare Choices Empowerment and Protection Act.
The legislation would have the CMS pay Medicare beneficiaries $75 for writing and registering digital advance directives, which would then be maintained online by accredited vendors certified by the CMS — ensuring that not only could beneficiaries' doctors access the directives but the CMS would also have on file which organization hosts which beneficiaries' information.
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Currently, the CMS advocates a low-tech, hands-off approach to advance care directives, simply advising people via its website to keep copies of the directives "where you can easily find them;" give copies to health care providers, proxies, family and friends; and to carry a note "in your wallet" saying you have an advance directive.
The hands-off approach isn't working. "The current dynamic is somebody might have a form that's on their refrigerator, and if an EMT happens to see it and grab it, then great," Sharon Pearce, vice president of policy for the National Hospice and Palliative Care Organization, is quoted saying in the report. Pearce adds, "What's worse than not having a directive at all is having it and it not being followed."
At present, most directives are downloadable, coming as they do from both government and private companies. But many are not stored online, and while all states have advance care directives governed by their own law, just a few have registries for those directives, and most must be filed by mail, not electronically. There are private options, but if health care professionals and families aren't aware of the document's existence, they're not much help either.
While there's no national directory, nor a standardized directive good throughout the country, as well-intentioned as this bill is, it doesn't solve those problems. If families don't have the conversation in the first place so that an advance directive is actually created, it won't be there to be used in the first place.
With multiple organizations pushing for people to create advance directives, and even providing kits to do so, a companion push by the government to make it happen could go a long way.
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